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# Diclofenac (Oral Tablet)
## Overview
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Pain associated with osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Pain management (mild to moderate)
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally three times daily, or 75 mg orally twice daily. Maximum dose: 225 mg/day.
* **Pain Management:** 50 mg orally every 8 hours as needed. Maximum dose: 150 mg/day.
* **Delayed-release formulations:** Typically dosed once or twice daily. Specific dosing varies by product.
## Pediatric Dosing
Limited data. Safety and efficacy not established for children younger than 1 year. For children 2 years and older, doses can range from 1-3 mg/kg/day divided into 2-3 doses. Consult specific pediatric guidelines or literature.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Start with a lower dose (e.g., 25 mg twice daily) and monitor closely. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function. Avoid in severe renal impairment.
## Contraindications
* Known hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or ulceration.
* Severe heart failure.
## Adverse Effects
* **Common:** GI upset (nausea, vomiting, diarrhea, constipation, abdominal pain), headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events (myocardial infarction, stroke), serious GI bleeding and ulceration, hepatotoxicity, renal toxicity, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, heart failure, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, diuretics:** May decrease antihypertensive effects and increase risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **GI:** Signs and symptoms of GI bleeding or ulceration.
* **Cardiovascular:** Blood pressure, signs/symptoms of cardiovascular events.
* **Renal:** Renal function (BUN, creatinine) particularly in patients with risk factors.
* **Hepatic:** Liver function tests (LFTs), especially with prolonged use or in patients with hepatic impairment.
## Clinical Pearls
* Lowest effective dose for the shortest duration should be used to minimize risk.
* Consider co-administration with a proton pump inhibitor (PPI) or misoprostol for patients at high risk of GI complications.
* Patients with existing cardiovascular disease or risk factors are at increased risk of cardiovascular events.
* Can mask signs of infection.
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**Disclaimer:** This information is intended for clinical decision-making and does not replace the need to consult the most current prescribing information or relevant clinical guidelines. Always verify with up-to-date resources.
